Abstract
Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. Methods. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. Results. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. Conclusion. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.
Highlights
The allocation of intensive care unit (ICU) beds for elderly patients has always been a matter of concern
The main goal of this study was to describe the clinical characteristics of the elderly patients with COVID-19 admitted in Romanian ICUs
The study objectives were to evaluate ICU mortality, to determine the factors associated with ICU mortality, and to determine whether age per se is associated with ICU mortality
Summary
The allocation of intensive care unit (ICU) beds for elderly patients has always been a matter of concern. During the surges of the COVID-19 pandemic, scarce ICU resource allocation became a major problem for decision makers and health care workers in a globally overwhelmed. The allocation of ICU beds to elderly patients was costly and associated with poor outcomes, but would possibly withhold valuable ICU resources from younger patients. The problem of ICU beds allocation to elderly patients during the COVID-19 pandemic has been addressed heterogeneously by different health care systems [14–16], and this challenging age category was targeted by different public health measures [13]. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from
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